I saw the endo today for the myriad of hypothyroid symptoms I have endured for the past approx. 1 1/2 years, and she said I probably have hypothalamus damage due to the hydro and my violent delivery, so my cortisol is likely much lower than it should be, and she wants me to take ACTH to bring it back up! Just what I need...a freakin' steroid after working my @$$ off to lose 90 lbs in 18 months!

Do I even have a prayer?? Has anyone done this? We won't have my test results back for at least a week, but she said I definitely have enough signs of a "problem" and that even though phenobarb can skew results, we'll probably go ahead and start treatment even if my levels are "close to normal."


LIZARD

Also known as: Corticotropin
Formal name: Adrenocorticotropic hormone
Related tests: Cortisol, Cortrosyn (ACTH) stimulation test, Dexamethasone suppression test
The Test
How is it used?
When is it ordered?
What does the test result mean?
Is there anything else I should know?

How is it used?
ACTH levels in the blood are measured to help detect, diagnose, and monitor conditions associated with excessive or deficient cortisol in the body. These conditions include:
Cushing’s disease: excess cortisol that is due to an ACTH-producing tumor in the pituitary gland (usually a benign tumor)
Cushing's syndrome: refers to the symptoms and signs associated with excess exposure to cortisol. In addition to Cushing’s disease, Cushing’s syndrome may be due to an adrenal tumor, adrenal hyperplasia (increased adrenal cell growth), the use of steroid medications, or due to an ACTH-producing tumor that is located outside the pituitary (such as in the lungs).
Addison's disease, primary adrenal insufficiency: decreased cortisol production due to adrenal gland damage
Secondary adrenal insufficiency: decreased cortisol production because of pituitary dysfunction
Hypotituitarism: pituitary dysfunction or damage that leads to decreased (or no) hormone production by the pituitary – including ACTH production
Measuring both ACTH and cortisol can help to differentiate among some of these conditions. Because the level of ACTH normally changes in the opposite direction to the level of cortisol, your doctor can learn much by identifying an imbalance in this relationship and the direction in which the imbalance occurs. The table below indicates the common patterns of ACTH and cortisol seen with different diseases involving the adrenal and pituitary glands. Disease
Cortisol
ACTH
Cushing's disease (pituitary tumor making ACTH)
High
High
Adrenal tumor
High
Low
"Ectopic" ACTH (ACTH made by a tumor outside the pituitary, usually in the lung)
High
High
Addison's disease (adrenal damage)
Low
High
Hypopituitarism
Low
Low



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When is it ordered?
This test is ordered when a patient has signs or symptoms associated with excess or deficient cortisol.
Too much cortisol often causes symptoms such as obesity (especially if it spares the arms and legs), a rounded face, fragile and thin skin, purple lines on the abdomen, muscle weakness, acne, and increased body hair. It is often accompanied by findings such as high blood pressure, low potassium, high bicarbonate, and high glucose (or even diabetes).
Patients with insufficient cortisol production may exhibit symptoms such as muscle weakness, fatigue, weight loss, increased skin pigmentation (even in areas not exposed to the sun), and loss of appetite. This is often accompanied by findings such as low blood pressure, low blood glucose, low sodium, high potassium, and high calcium. Symptoms suggestive of hypopituitarism include loss of appetite, fatigue, irregular menstrual cycle, hypogonadism (lower levels of sex hormones in males), decreased sex drive, frequent nighttime urination, and weight loss. When the condition is due to a pituitary tumor (usually benign), the patient may also have symptoms associated with the compression of nearby cells and nerves. The tumor can affect the nerves controlling vision, causing symptoms such as "tunnel vision" (inability to see things off to the side), loss of vision to some localized areas, and double vision, and can cause a change in a pattern of headaches.


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What does the test result mean?
NOTE: A standard reference range is not available for this test. Because reference values are dependent on many factors, including patient age, gender, sample population, and test method, numeric test results have different meanings in different labs. Your lab report should include the specific reference range for your test. Lab Tests Online strongly recommends that you discuss your test results with your doctor. For more information on reference ranges, please read Reference Ranges and What They Mean.


Changes in ACTH and cortisol are usually evaluated together, as shown in the table above.
An increased ACTH result can mean that a patient has Cushing's disease, Addison's disease, or ectopic ACTH-producing tumors. A decreased ACTH result can be due to an adrenal tumor, steroid medication, or hypopituitarism. In some cases, the interpretation of the results can be complex. Concentrations of both ACTH and cortisol vary throughout the day. Normally, ACTH will be at its highest level in the morning and lowest at night. It will stimulate cortisol production, which will follow the same pattern but will rise after ACTH does and fall to its lowest level very late in the evening. Conditions that affect the production of ACTH and cortisol often disrupt this diurnal variation (daily pattern).

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Is there anything else I should know?
Testing the change in cortisol when certain drugs are given often helps to clarify the picture and allows the doctor to make the right diagnosis. The most commonly used drugs are cortrosyn (cosyntropin, a drug form of ACTH) for an ACTH stimulation test and dexamethasone for a dexamethasone suppression test.
Cortrosyn, like ACTH, stimulates the adrenal glands to make cortisol. If cortisol levels don't rise after cortrosyn is given, this indicates adrenal failure as can occur in Addison's disease or hypopituitarism.
Dexamethasone is a very potent drug that acts like cortisol. In normal people, it should stop ACTH production. By testing the ability of different doses of dexamethasone to stop ACTH production, it is often possible to tell if the patient has Cushing's syndrome and help determine its cause. A number of other drugs are sometimes used, including insulin, corticotropin releasing hormone, and metyrapone (metapyrone). Some drugs and conditions can cause ACTH levels to rise, including amphetamines, insulin, levodopa, metoclopramide, and RU 486.

Drugs that cause ACTH to fall include dexamethasone and other drugs that act like cortisol (including prednisone, hydrocortisone, prednisolone, and methylprednisolone), and megestrol acetate.

Secretion of ACTH may be increased by stress.

ACTH has also been used as a drug to treat Multiple Sclerosis.

May I have the low cortisol please? I need to loose the weight!

My endo suspects mine is low, and I have gained and lost the same 4 lbs for about 6 months!


LIZARD

P.S. Thanks, Biz! This is a great site! I bookmarked it for future ref.

lizard...try and find out exactly what steroid your dr is going to rx. different ones and different doses have different side effects.

there is a lot you can do to combat any of the fluid retension. also the steriod can help you build muscle. thus..more muscle to burn more calories after. lol..not like arnold muscles.

how long of a treatment? i'm full of question she might not have answered yet.

Thanks, Curious.

I just got tested Monday, and I don't know everything she tested for, so I won't know much of anything 'til the results come in. I understand it could be as long as two weeks! We don't even know for sure yet if the ACTH is what's needed, but if it is, I hope it won't be too long. I know the stuff makes you gain. My best friend's little guy, who has Infantile Spasms, was on it for at least a couple of months. He's much better now since he's off of it , so I'm concerned that it might mess with my sz threshold, too. No time for that! My life is too crazy for any more health crises.


LIZARD

Hugs Lizzard, I pray the outcome will be the best for you. Try not to worry to much and think positive. Much love, gaye